Comparison of timing for early postoperative intake in patients with upper gastrointestinal cancer: a network meta-analysis.

BACKGROUND: Surgeons have traditionally believed that early postoperative oral intake in patients undergoing surgery for upper gastrointestinal cancer increases the risk of complications, particularly anastomotic leakage. In recent years, advances in surgical technology (e.g., surgical staplers) have provided opportunities for earlier oral nutritional intake. Nevertheless, comparative data in the literature on the optimal specific timing of early postoperative oral intake remain scarce. METHODS: A comprehensive literature search was conducted using databases including PubMed, Embase, and China National Knowledge Infrastructure (CNKI) to identify clinical trials, mainly randomized controlled trials (RCTs) involving patients who underwent surgery for esophageal cancer. Data were extracted regarding the following outcomes: anastomotic leakage, pneumonia, postoperative length of stay (chosen over total length of hospital stay due to the latter’s susceptibility to multiple confounding factors), postoperative complications, postoperative oral intake intolerance, and time to first postoperative flatus. These data were collected to assess the impact of early oral intake timing on postoperative recovery and complication rates, thereby providing information for predicting the optimal time to begin oral intake. A random-effects model was employed for the subsequent network meta-analysis. RESULTS: Fifteen RCTs involving 1,986 patients was analyzed. Initiating oral intake after gastrointestinal function recovery (GFR) can lower the risk of oral feeding intolerance (SUCRA:0.079, RR:0.13, 95% CrI:0.013 ~ 0.72). For all other outcomes—including anastomotic leakage, postoperative complications, pneumonia, postoperative length of stay, and time to first flatus—no comparison reached statistical significance. However, point estimates and SUCRA rankings suggested potential trends that GFR was ranked best for reducing anastomotic leakage, POD1 for shortening hospitalization and time to flatus, and POD4/5 for lowering total complications and pneumonia rates. CONCLUSIONS: Postoperative feeding timing is a trade-off: earlier for recovery versus later for safety. Initiation at POD4/5 may be a balanced option, albeit with effects not reaching statistical significance.